Provider Demographics
NPI:1659563351
Name:PAIN MANAGEMENT, PLLC
Entity Type:Organization
Organization Name:PAIN MANAGEMENT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-220-0070
Mailing Address - Street 1:PO BOX 4547
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37831-4547
Mailing Address - Country:US
Mailing Address - Phone:865-220-0070
Mailing Address - Fax:
Practice Address - Street 1:140 E DIVISION RD STE A1
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6900
Practice Address - Country:US
Practice Address - Phone:865-220-0070
Practice Address - Fax:865-220-9918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3379916Medicaid
TN3379916Medicaid
TNG16560Medicare UPIN